Harm OCD, like all the other domains of obsessive-compulsive disorder, is very disruptive. The harm domain involves any intrusive thoughts that involve hurting yourself or someone else, either purposefully or accidentally. It is important to note that OCD intrusive thoughts are not connected to desire. Someone suffering from harm OCD has absolutely no desire to harm anyone. At first clients are often confused and even terrified by these thoughts or images. Because the thoughts and images become so persistent, they will take them very seriously and question their own safety. I’ve often have people call me asking if they should leave their home so that they are not around their loved ones whom they fear they could hurt. My answer is always “no” because harm OCD does not indicate desire, and the person simply needs to engage in exposure response prevention treatment (ERP). People are often surprised to find out just how common harm OCD is because most people are afraid to admit it to themselves, much less to someone else. We often have close family members involved in at least one session so that the loved ones understand what the client is experiencing and how they might be able to help with treatment.

Common harm OCD obsessions:

Hit and run OCD is when someone fears that they hit someone while driving. For example, they may see something lying on the road and fear that they hit someone. The client will turn their car around to check to make sure a body is not lying on the road. I’ve even had clients check the news online for any hit and runs reported that include the make and model of their vehicle. A fear of somehow being responsible for a burglary or fire is also very common. These clients will check all heating appliances, locks, and even faucets prior to leaving their home for an extreme amount of time. I had one client, who when leaving her home, would take her air fryer and toaster with her in the car so that she knew with certainty that those appliances could not cause a fire. She lived in a condo block and did not want to be responsible for neighbors potentially dying in a fire that she might cause unintentionally. Knives and other perceived weapons are triggers. I have numerous clients per year who fear that they might purposefully stab a loved one with a knife even though they do not desire doing so, or fear that they will somehow become out of touch with reality (psychosis or sleep walk) and then stab someone. These clients will sometimes avoid knives to the extent of having their loved ones hide the cooking knives in the home. Since the ‘me too’ movement, I’ve seen an influx of people (primarily men with OCD) obsessively reviewing their past to ensure that they have not sexually assaulted a woman or they worry that they may someday sexually assault someone. Suicide is another common theme. These clients have unwanted thoughts or images about killing themselves with a knife, overdose, jumping off buildings, or any other number of ways. OCD can be so clever that some clients will obsess about their OCD (or another mental health concern) becoming so severe that they fear they will want to end their lives.

Exposure Response Prevention (ERP)

ERP is the gold standard treatment for OCD. The treatment involves steadily exposing a client to their fears until they habituate (the fear no longer exists). Harm OCD may sound like a difficult disorder to overcome, but in fact it is typically quite easy to treat. The triggers are usually well defined allowing therapists to quickly create a treatment plan or hierarchy of exposures. In other words, if a client wants to avoid knives, then they must do various exposure involving knives. If they want to avoid tall parking garages, they will need to do various exposures on buildings of varying heights. If the client is avoiding certain people for fear they will harm them, they will need to be around those people even more. If you struggle with this form of OCD, it might seem scary to think of these kinds of exposures, but it is important to remember that the therapist will be doing the exposures with you first, and you will ultimately determine what exposures you will or will not do. As a therapist who treats OCD, I know that my job is to challenge the client, but I must also set them up for success, which is why I typically assign exposures based on a hierarchical approach (starting with low difficult exposures and working towards the higher difficulty exposures). 

Why you should seek treatment with us

Providers at Anxiety & OCD Treatment of Tampa Bay have received extensive training in OCD and we have experience treating some of the most severe cases of OCD in the partial hospitalization program. We see clients from all over the state of Florida. Many clients have tried treatment with other providers who may have so little experience treating harm OCD that they don’t even realize that there is an OCD component present. Many other providers claim to treat OCD, but are not true specialists and the clients do not attain full functioning. Because there is such a stigma with this domain of OCD, the providers at Anxiety & OCD Treatment of Tampa Bay often integrate humor in the treatment process. Clients typically take their thoughts and images so seriously. We teach our clients just how predictable OCD really is and how to make light of it. Thoughts are only thoughts, and should not make up your sense of self-worth. No thought is that powerful and we will teach you to not give them such power.

Contact us today!

There is no need to continue living in fear. You will become an expert in ERP while working with us. We will teach you how to come up with exposures and we will certainly teach you about relapse prevention. While there is no cure for OCD and you might still need to seek a therapist from time to time for “tune up” sessions, we will teach you how to remain independent in your ability to manage symptoms. Call us today for a free consultation!



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